When Constipation Isn’t What You Think...

The Right-Sided Gut Motility Puzzle in Long Covid, POTS & Chronic Dysautonomia

By Rachel Jessey MSc, DipNT

Clinical Naturopathic Nutritionist Specialising in Complex Conditions

Over the past few years, working with individuals experiencing Long Covid, POTS, MCAS, and other forms of dysautonomia, one theme continues to emerge, subtly at first, but now so frequently that it demands deeper clinical attention. My attention first started to focus on this problem after my most recent podcast with Dr Philip McMillan where he showed me an x-ray of a patient with right sided faecal loading. I had never heard of this before so I took a deeper dive and here is what I have uncovered.

Clients with suspected faecal loading nearly always report some form of digestive disruption, often labelled as constipation, and may also present with bloating, reflux, food intolerances or SIBO type symptoms. But what becomes apparent, especially when digging beneath symptom labels and into imaging, palpation, or response to interventions, is that this “constipation” is often something else entirely.

It’s not always about frequency of bowel movements. It’s about where the stool is retained, why motility is misfiring, and how the body's internal communication systems, especially the vagus nerve and enteric nervous system, are disrupted. And surprisingly often, the problem isn’t left-sided transit delay, as textbooks would have us expect. It’s right-sided faecal loading.

This pattern may seem minor, even obscure, but I now believe that it is one of the most clinically significant gut-brain-immune patterns I see in practice. And it's changing the way I work with complex patients from the very first appointment.

The Problem with Labels

Traditional definitions of constipation focus on infrequency, three or fewer bowel movements per week. But in clinical reality, many people who "pass a bowel movement daily" still experience bloating, heaviness, a sensation of incomplete evacuation, mucus in stool, and even episodes of overflow diarrhoea. These signs are often dismissed, both by the person experiencing them and by clinicians, simply because the person is “regular.”

But what I am frequently finding is that these clients are possibly dealing with faecal loading which is the build-up and retention of stool, which in some cases can be dry and compacted, in particular regions of the colon.

I suspect that for many people with chronic illness, this retention doesn’t occur where we expect it, in the descending colon or rectum, but instead builds up on the right side of the colon: the caecum, ascending colon, and hepatic flexure.

This is not a benign finding. The right side of the colon is intimately linked with upstream gut function, especially the ileocecal valve (ICV) and the small intestine. It is also regulated predominantly by the vagus nerve, a nerve that, in the context of chronic inflammation, viral damage, and dysautonomia, is often dysfunctional or underperforming.

When stool accumulates in the right colon, the consequences extend far beyond digestion. The ileocecal valve, which is the vital gateway separating the small intestine from the large, relies on both vagal tone and digestive hormones to open and close in a timely, coordinated fashion. Its job is to allow digested food to move into the colon, while preventing colonic contents from backflowing into the small intestine.

When the right colon becomes backed up, whether from slow motility, neuromuscular misfiring, or inflammation, the valve often remains closed under pressure or begins to dysfunction entirely. This creates a chain reaction that’s both mechanical and neurological, leading to the kind of widespread systemic symptoms that clients and practitioners alike often struggle to connect back to the gut.

How Right-Sided Faecal Loading Triggers Systemic Chaos

When this right-sided stagnation develops, we often see a familiar cascade of issues unfold, seemingly unconnected at first:

• Slowed motility and abdominal pressure resulting in the inability to effectively move stool forward, so meals feel “stuck” or cause bloating shortly after eating.

• Upper GI distress symptoms can manifests and present as nausea, reflux, early satiety, or even vomiting in some people, this is the result of the digestive system becoming congested from both ends.

• Small intestinal overgrowth (SIBO/SIFO) can develop due to the ICV function becoming compromised, bacteria and fungi can translocate into the small intestine, setting off bloating, food intolerance, fatigue, fluctuating stools and inflammation processes.

• Blood sugar instability which can trigger increased POTS type symptoms, fatigue and mood disturbances

• MCAS-type symptoms histamine or multiple food reactions, flushing, and sensitivity to supplements or medications often appear in tandem.

• POTS flare-ups caused by blood pooling to the GI tract post meals result in blood pressure drops, dizziness, and post-meal fatigue and destabilised blood sugar levels.

This progression is not hypothetical. It’s something I’ve seen repeatedly in clients with Long Covid, POTS, and chronic immune dysregulation, many of whom had been through years of SIBO protocols, probiotics, restrictive diets, and antimicrobials that never seemed to stick.

Which brings us to the elephant in the room.

When Probiotics and Antimicrobials Backfire

In the functional medicine world, there is an understandable drive to test and treat microbial imbalances: SIBO, candida, dysbiosis. But in clients with underlying faecal loading, particularly on the right side this approach is often not only ineffective, but counterproductive.

Here's why:

Probiotics, even those considered gentle, can worsen symptoms if the colon is already congested. They increase gas production, raise colonic pressure, and may inflame the mucosa if the local immune system is already hyperactive. They can also inadvertently trigger immune reactivity if introduced into a system that hasn’t yet re-established motility.

Antimicrobials, whether pharmaceutical or herbal, carry their own risks. When used in a gut that’s physically congested or neurologically dysregulated, they can:

• Increase die-off symptoms due to poor clearance

• Damage the mucosal lining and tight junctions

• Trigger flares in those with MCAS or histamine issues

• Deepen vagal dysfunction, especially if they disrupt gut-brain communication

Time and time again, clients tell me that they felt worse after SIBO treatment ending more reactive, more bloated, more fatigued. It’s not that the diagnosis was wrong, but that the terrain wasn’t ready.

The Hidden Players: Toxic Peptides and the Gut-Virus-Microbiome Axis

I have spoken a lot over the years about Carlos Brogna's proposed groundbreaking mechanism behind some of these gut disruptions. Brogna has suggested that SARS-CoV-2, even after the acute infection resolves, may produce toxic peptides through non-standard RNA translation. These peptides, he argues, can persist in the body and act almost like viral toxins, disrupting cellular signalling and immune regulation.

More provocatively, Brogna hypothesises that these peptides might interact with the gut microbiome, particularly with Clostridia species. This group of bacteria, known for its complex role in both health and disease, may become more virulent or inflammatory in the presence of these viral remnants. Some Clostridia can produce neuroactive toxins, modulate serotonin pathways, or interfere with bile acid metabolism, all of which can drastically alter gut motility.

Moreover, if viral peptides or phage-like elements from SARS-CoV-2 modulate microbial gene expression, this could create a self-reinforcing cycle: viral elements sustain microbial imbalance, microbial metabolites sustain inflammation, and the enteric nervous system becomes increasingly dysregulated. In essence, the virus, it leaves dysfunction.

A Gut That Has Forgotten Its Rhythm

In a healthy digestive system, eating a meal initiates a cascade of neurological and hormonal responses. The stomach stretches, signalling the release of hormones like motilin and gastrin. The small intestine begins peristalsis. And most importantly, the colon receives a reflex signal to clear space, this is the gastrocolic reflex, often felt as the urge to move the bowels after eating.

But this requires two things: motility and tone. And both are dependent on vagal signalling.

When the vagus nerve is compromised, as it frequently is in Long Covid, POTS, and post-viral syndromes these reflexes no longer work in harmony. The colon loses its pacing. The ICV becomes tense or stuck. Motility is no longer a rhythm, but a set of disjointed spasms and stagnations. Stool builds up not because nothing moves, but because the timing and sequence are lost. In this context, right-sided faecal loading is not just a symptom it is a signpost of disorganised signals, and the downstream consequences are vast.

Rebuilding Rhythm: A Nervous System-First Approach

My clinical approach begins not with testing or supplements, but with re-regulation. Before reshaping the microbiome, we must restore motility, vagal tone, and digestive sequencing.

This includes:

• Vagus nerve support, breath, pelvic floor exercises, postural realignment and in some cases some people may need referral for venous and nerve compression syndromes that can effect bowel motility

• Abdominal massage, castor oil packs, and addressing mineral balance

• Gentle pressure release around the ICV

• Circadian retraining

• Address bacteriophage or persistent viral replication in the gut

• Prokinetics in some cases may be helpful

This is a much more sensible approach than overloading and already congested gut with yet more medications and supplements.

A Closing Thought: Seeing the Bigger Picture

Right-sided faecal loading may seem like an obscure observation. But when viewed through the lens of viral persistence, microbiome disruption, and nervous system disfunction, it becomes a powerful clinical clue.

Carlos Brogna’s work may still be emerging, but it mirrors what we’re already seeing: that gut dysfunction in Long Covid is not just a local issue. It’s systemic. It’s sustained. And it’s deeply interwoven with immune signalling, microbial activity, and neurological tone.

If you're someone, or supporting someone, who has tried everything and still struggles, perhaps it’s not about trying harder. Perhaps it’s about listening more carefully to where the story began.

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